As medical facilities are targeted, and the siege in and around Aleppo tightens, wounded Syrians have fewer and fewer places to turn to. Anna Lekas Miller reports from Antakya.
Judging by the increased number of airstrikes on Aleppo and neighboring towns, the endgame for Aleppo may well be underway. A few days ago, a series of 26 Syrian regime and Russian airstrikes hit the opposition-controlled town of Al-Atareb, just west of Aleppo, killing 42 civilians over the course of 24 hours.
After the town's only hospital was struck four times over the course of 90 minutes, the operation room was no longer functional, leaving the critically wounded in need of immediate surgery with nowhere to be treated. Though a number of them have been sent to Turkey, it is only the most critically wounded who are given permission to cross into the country - and the trip to the border often poses additional dangers.
"Depending on where a patient is, transporting them to Turkey can require going through SDF [Syrian Democratic Forces - the ed.], IS, or regime-controlled areas," Dr. Hassan, who oversees medical evacuations with the Independent Doctors Association, told DW. "Often it isn't worth the risk."
No way out
Just a few miles away from the devastation in Al-Atareb, the wounded in Aleppo city have even fewer options.
Since the army of the Syrian regime in July advanced upon, and closed, Castello Road - the single artery linking the opposition controlled eastern part of the city with the regime-controlled west - the city has been under a complete siege.
"Everything has changed under the siege," Khaled, a 25-year-old working with the Syrian Civil Defense, a group of civilian-led emergency rescue workers, told DW.
"We are starting to run out of food," he said. "The price of a kilo of rice has gone from 100 to 500 Syrian Pounds (41 euro cents to 2 euros). Most of the stores have closed their doors."
For Aleppo's medical workers, who have earned a reputation for continuing their work even in the most dire of circumstances, the siege is providing an additional set of challenges. While Castello Road is notoriously dangerous - with airstrikes targeting anything that moves - it was nevertheless an essential lifeline into the city, particularly for the medical community. Now, the 33 remaining doctors in the city are relying on emergency reserves of medical supplies to treat the multiplying number of war injuries, and increasing cases of malnutrition as other hospitals are bombed out of operation.
"The hospitals are overloaded," Dr. Mohamed Katoub, the Advocacy Director for the Syrian American Medical Association (SAMS), who has been going in and out of Aleppo to provide relief work, told DW. In Eastern Aleppo, the doctor-patient ratio, by even the most conservative estimates is 1:9,090 - compared to a global average of 1 to every 300 people. "They have to provide treatment for a far larger number of people than they are used to."
According to Katoub, medical workers have been expecting a siege and have been stocking up on supplies for the past six months. However, attacks like the targeting of a blood bank last Friday have shown doctors that though they might have prepared in advance, their supplies are not safe in the current environment.
The inability to move freely to see specialists outside the city, or be evacuated to Turkey if necessary, is also further constricting the ability of doctors to provide care for their patients, in an already difficult environment.
"There are several medical services we do not have inside the city," Katoub said. While this did not pose a problem before the siege, the inability for patients to travel outside the city has dramatically reduced their options for specialized medical care.
"We have only one neurosurgeon inside the city," he elaborates. "There is no way that he can deal with the amount of cases we have been receiving for such a long time."
Urgent medical evacuations
While Katoub and others advocating on behalf of doctors inside Syria are pushing for access to the road for urgent medical evacuations, there has been no response from the United Nations or the international community. The Syrian regime has alerted civilians that they can be treated in hospitals in the regime-controlled section of the city, but many patients that chose this option faced immediate arrest or interrogation upon crossing to the regime-controlled areas. Now, most patients refuse to accept this as a viable solution.
"The regime targets medical services because people cannot live without access to them," Katoub said. Now, an estimated 60 percent of all hospitals have been either completely or partially shuttered across Syria.
"You cannot live in a town where you cannot have access to vaccinations for your children, or get treatment if you are sick or injured. This is the main reason why people flee their towns."